Match each clinical scenario describing a high-risk infectious disease exposure with the most appropriate post-exposure prophylaxis (PEP) regimen.
- An unvaccinated healthcare worker sustains a needlestick injury from a patient who is positive for hepatitis B surface antigen.Hepatitis B immune globulin (HBIG) and initiation of the hepatitis B vaccine series.
- A 20-year-old college student shares a small dormitory room with a classmate who was just hospitalized with confirmed Neisseria meningitidis infection.A single dose of intramuscular ceftriaxone or oral ciprofloxacin.
- A 45-year-old camper awakens in a tent to find a bat flying nearby; upon closer inspection, a small, unexplained scratch is found on his arm.Human rabies immune globulin (RIG) and a multidose rabies vaccine series.
- A surgical resident suffers a deep scalpel laceration while operating on a patient with an unsuppressed, highly viremic HIV infection.A four-week course of tenofovir-emtricitabine combined with dolutegravir or raltegravir.
Answer
Match the specific exposure to its guideline-directed prophylaxis: Unvaccinated HBV exposure requires HBIG and vaccine; meningococcal close contact requires ceftriaxone, ciprofloxacin, or rifampin; potential bat exposure requires RIG and rabies vaccine; and high-risk occupational HIV exposure requires a 3-drug antiretroviral regimen.
Appropriate post-exposure prophylaxis depends entirely on the specific pathogen, the nature of the exposure, and the host's prior immunity. Bacterial exposures like Neisseria meningitidis require short-course antibiotics to eliminate carriage. Viral exposures like HIV require multi-drug antiretroviral therapy to prevent viral replication and integration. Pathogens with potentially lethal outcomes in naive hosts (Rabies, HBV) require a combination of immune globulin (for immediate passive protection) and vaccination (for lasting active immunity).
Step-by-Step Solution
Key Concept
Post-exposure prophylaxis (PEP) guidelines for high-risk infectious exposures